Urgent Care Center Improves Addiction Care, Eases ED Burden

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"We're able to do a better job that the ER [emergency room] is, and we're providing them with some ongoing services if they're interested," said Miriam Komaromy, MD, an internal medicine and addiction medicine specialist in Albuquerque, New Mexico, who presented the findings here at the American Society of Addiction Medicine 42nd Annual Medical-Scientific Conference.

Dr. Komaromy, who is also medical director of Turquoise Lodge Hospital and the Project ECHO Addiction Treatment Program, in Albuquerque, outlined the first year of the urgent care clinic, called the Medical Observation and Treatment Unit (MOTU), which was established in December 2009.

Funded by a consortium of local hospitals with the aim of reducing the burden on the local EDs and improving the quality of addiction care, the MOTU received a total of 4057 visits in its first year of operation, reported Dr. Komaromy.

The majority of visitors (70%) were men, with some repeat visits, for a total of 2117 "unique" visitors, she said.

Acute Care Focus

Patients came to the MOTU mostly by referral from the detoxification center next door but sometimes by ambulance (n = 356, 11%) based on predetermined triage criteria that included presence of vital signs, no head trauma, and a verbal and arousable state, she said.

The MOTU, operating from 7 am to midnight every day, is staffed by a medical professional, usually a physician assistant, 1 registered nurse, and 1 nursing assistant, with a physician on-call at all times, she explained.

Services are geared toward acute care and include medical tapers, medical and psychiatric management of acute problems, hydrations and intravenous infusion if needed, and some basic laboratory work.

Patients can stay no longer than 24 hours, after which they are discharged back to the detoxification center for a maximum stay of 3 days or a longer stay at an addiction treatment facility with referral to individual and group counseling. The operating cost per patient for 24 hours is approximately $300.

Rapid, Tailored Treatment

Of the 4057 visits in the first year, 84% of patients were discharged to the detoxification center, 10% to the addiction treatment hospital, and the rest to home. Less than 1% were transferred to the hospital ED, said Dr. Komaromy.

In an analysis of 100 sequential patients, she said 57 were addicted to opiates, and 57 were addicted to alcohol, with 17 of this group addicted to both. The rest were addicted to other substances, such as cocaine or marijuana.

A total of 43 patients had no problem other than addiction, whereas 23 had medical problems, such as hypertension, diabetes, asthma, abscess/cellulitis, gout, seizures, liver disease, migraine, and back pain; 17 had psychiatric problems, such as depression, bipolar disorder, anxiety, psychosis, schizophrenia, delirium, and suicidality; and 14 had both.

The urgent care model offers rapid and tailored care to patients who would otherwise be discharged more quickly from the ED, she concluded.

Asked to comment on the study, Dr. Gavin Bart, chair of the meeting's Medical-Scientific Program Committee and assistant professor of medicine and director of the Division of Addiction Medicine at the University of Minnesota Medical School in Minneapolis, said the urgent care center model makes sense.

"It's really an emergency room diversion program. At $300 per day for a patient, compared to an emergency room visit, which is most likely going to be at least $750 a visit minimum, we are already looking at incredible cost-savings."

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